GW1--07055_Well Construction - GW1_20231102

WELL CONSTRUCTION EC R GW-1
For internal Use Only
I.Well Contractor information:/
14.►VATER ZONES»..-i - _ - .
Well Contractor Name 'R()M11� 1.0 ___.,.�.__ _.--
1>dH RIP 1 rpN
•• . o 7 3L) •- 11 rt,
NC Well Contractor Certification NumberfL It.
I 15;OUTER CASING(for multi-cased}welts OR-LINER-if aide)
ee,I -c 4:,-4e 13r-;i oil t4,/tC'j F qM_ _ TO DIAMETER TN1ClCNSSS MATERIAL
Company Name
../ ft. IL 1n.
C _
1R hNiVER CASING-OR T .., DIAMETER 4ermrr clICKNESS
i.Well ,h/action Permit l;r y JQ r f[' L. i R[s.F7 -__ _.Y
_ TO, _. DIAMETER _.. _._._._ .,�_
I.in all appheabk well con.strucNett,pc its(ix.U/C Cooing Stale, Variance,etc.) ft. fr. In. THICKNESS MATERIAL
3.Well Use(check well use}: yerres' / &/5"'` r e ,..___._.._._ _-
Supply Well: _ --- - ._.,.— -
r7,SCREEN ----------
Water _
0/l)riculttrtzs! 0hlunicipal/Public ~FROM TO DIAMETER SI41IZE n x rss-,_.iit�t litia"
8. in; _,
DGeothcrmal(Heating/Cooling Supply) OResidential Water Supply-(single) "-"� _._,._„_.__ ry
C7lndustriaV C'gmtnerrntl et is
C)Residential Writer Supply(shared) -_— _
CJhri ration ltl.GRI)C T - -.
0 Wells'> 100,000(,Pt) FRttl1N To INA7 ttm.. I.MPLACEMENTME:Ttt(J�&Aaiii,�VT_�
Non-Water Supply Well: ft. - R4_ _..W_.
CJMonitoring ❑itecnvery `""'....`"_. - —
Injection Well: .w ..._.__ __ fk. ft. rw __�
•
•
git,fer Recharge li a ndwater IZerne<Iintion ft. ft.
DAyuifer Storage and Recovery (�5aiinity Barrier FROM
SAND/GRAVE L PACK ltimpli ahre) -^ -
PROM TO M
.TRRlAt EM? AtaM NTMThI(Cb
°Aquifer Test ©Stor•rnwatey Drainage ft... ft.
[7Experimental Technology OSubsidtatct Control
n ft.
OGeothenmal(Closed Loop) CiTmccr
20 IIRILLiNG LOG(sttRrh additional sleets if necessary)
EI icotherrual(Health Coolin g Return ther(explain under#21 R.cmarks) FROM TOI�FSLNIP Iprti„br,hawaeu,mrurocR cypr,gmio.h .u,)
�� -,i . e4)adf�`�' ,51'el. rtr.+c. c'iliS`'..,
4.Date Well(s)Completed:. _._._._..r _ Well 11)fl,w�� ` 2 S tt. --h n. t^�
_._+ u�rr ..t�ur tic - _
5a.Well Location:
ft. n. __._�_.._
)lour C 0,4,4erS Su ++r-Fvv4. ,.S;le y 1, qqq -". ft. __
Pacility/Owner Name Facility Mk(it applicable) _-r• __ ._ rt. N V 0 2 2023
.2 /z-?[jeu .e t,1✓f i.., ;.(1►,x�o,>,�✓Tied, 2 S.5"Ve _ >t. __ �.» �_...
Physical Address,City,and Zipft. IL '`Z�U •' -
ON., /!?U.t 21 14/3 7 ., [ 21.REMARKS _�� w �
County runes!hlsntitient on No.(PIN) a (. /q
Tl_R
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Set . `, ) 'dt,xt•hs.!;r'rte.-t r I m r e°'''S frs✓Y I ..elal1 1
(if well field,one latoong is sufficient) 22.Certification:
3'L.7 Li/ .0 0 ___....._N / 7, 3 �I e t.) 'V
l - �p-1�2-)3
6.(stare)the well(s): i1it'ermanent or °Temporar t Signature of Certified well Caoutre'tnr Oak
ity signing this Jarm.1 hereby(tn li/j'that the'wilts)was(ire-')emitita'1Cd in aecortcnrcr*Oh
7.is this a repair to an existing well: LJYes or ANY, 154 NC,4C 02C 0100 nr 114 NCAC 02C.020i9 Well,Construction Standards and t iux d.t'1
Iflhte Ls a repufr,Ji11 urn known well construetinn infi�rinatirnm nod e.tplant the natm r of the of this record has been provided to he ur17 owner
repair under 021 trnia/u section or on the hack a/thb,[Drat.
23.Site diagram or additionat well details:
You may use the back of this page to provide additional well construction into
S.For Creoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction,only 1 GW-1 is needed, Indicate TOTAL NUMBER of wells (add'Sec Over'in Remarks Bost You may also attach additional pages if nele;snr ,
drilled:
_.,_ 24.SUBNIIITTAL INSTRUCTIONS
9.Total well depth below land surface: 't (' _(ft.) .�
Par multiple wmlli list all depths ilehferent(ertunp k-9(it100'and 2 i�1110) Submit this C,iW--1 within 30 days of well completion per the following:
10.Stalk water level below top of casing; (ft 24a. For All Wells: Original form to Division of Water Resources: (DWR),
IS level i,e n1Mv@ casing,rest "+
)
informationProcessing Unit, 1617 MSC,Raleigh,,NC 27699-1617
II,Borehole diameter: 1 tin,) 241t, For Injection Wells:Copy tt>DWR, Underground Injection Control(ItAC:)
Program, ib36 MSC,Raleigh,NC 27699-1636
12.Well construction method: .it 0 fa- Z/d'Yi t - .._._. 24c.For Water Supply[ and Open-Loop Geothermal Return Wells;Copy to the
0 e.auger,rotary,cable,direcr ptruh,aye.) .«. .. countydtviromnental health d_ epattment of the county where installed
FOR WATER SUPPLY WELLS ONLY: __._ -.w._.»
24d.For Water Welke producing over 100,000 GPD: Copy to DWR,CCPCUA
13a.Yield t m Permit Program, 1611 MC.,Raleigh,NC 276'+9-16l l
(gP ) Method of test: ___,_ _...___
Oh.Disinfection type:__,_ Amount: .__
t+nrm rw_r ,...-4.r-__..a_.,.... . .- ..

410 TERRATHERM ISTD Heater Boring Construction Detail Revision It: 0
" ' ""' " Release date: 5/12/23
Approved by: 5S1..
Well ID H-49 Date / GO 03 —d`-.1
- • Oversight c,1-3—..13as_ 1 A Job# R23-104
�JQ^ ,t
Driller C ^L/ '7"'f
r
Constructed
(fill out if
Design different) Notes
—Stick Up Height /24/-s --
1/2"Thermocouple pipe? "
Thermocouple Length 27.67' C
Ground Surface 0.0'
-------------------------
Heater Can Conductive HT Grout—' •ngle from Horizontal 90"
Schedule 40
Borehole Diameter 6"
n
Heater Can Length 28 ft 5 Gal Buckets of Graphite 1.25
Bags of Silica _1.75
Heater Can Diameter 3 In
Bags of Cement 6
Installation Method
D�iec tush
(`SQTiic
Hollow Stem Auger
Mud Rotary
Other:
Bottom of Heater Can 26'
Y j Bottom of Borehole 26'
Post-Installation QC(to be performed 24hrs after installation) PID Log:Make/Model:
1)Confirm well is free of grout Design Constructed Time: to 4 ` p eN Reading: # . 0 PPM
Depth to bottom of well[ft bTOC 7R' Time: Reading: PPM
If greater than or equal to 1ft less than designed alert the office Time: Reading: PPM
2)Confirm grout plug reaches ground surface Time: Reading: PPM
repeat daily until depth to grout is Oft. Time: Reading: PPM
Date Depth to Grout[ft bgs] Notes: